Method using a combination reamer/drill bit for shoulder arthroplasty

ABSTRACT

A method of preparing a shoulder to receive a glenoid component in one embodiment includes accessing a glenoid of a shoulder, applying a rotational force to a combination device, forming a first bore in the glenoid with a rotating boring section of the combination device, forming a second bore in the glenoid at a location spaced apart from the first bore using a first drill guide defined by the combination device, and reaming a portion of the glenoid with a rotating reaming section of the combination device, wherein forming a first bore and reaming a portion of the glenoid occur at least partially simultaneously.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of copending U.S. application Ser.No. 15/793,229 filed on Oct. 25, 2017, which is a divisional applicationof U.S. application Ser. No. 13/051,026, entitled “CombinationReamer/Drill Bit for Shoulder Arthroplasty” filed Mar. 18, 2011, whichissued on Nov. 21, 2017 as U.S. Pat. No. 9,820,758 and which is relatedto U.S. patent application Ser. No. 13/051,011, entitled “CircularGlenoid Method for Shoulder Arthroscopy”, which was filed on Mar. 18,2011 and issued as U.S. Pat. No. 8,764,836 on Jul. 1, 2014, U.S. patentapplication Ser. No. 13/051,041, entitled “Device and Method forRetroversion Correction for Shoulder Arthroscopy”, which was also filedon Mar. 18, 2011 and issued as U.S. Pat. No. 9,226,830 on Jan. 5, 2016,and U.S. patent application Ser. No. 13/051,062, entitled “RevisionGlenoid Device and Method”, which was also filed on Mar. 18, 2011 andissued as U.S. Pat. No. 8,551,177 on Oct. 8, 2013, the contents of whichare each incorporated herein by reference.

TECHNICAL FIELD OF THE INVENTION

The present invention relates generally to the field of orthopedics,and, more particularly, to glenoid component apparatuses for shoulderarthroplasty and methods for using them.

BACKGROUND

As depicted in FIG. 1, a typical shoulder or glenohumeral joint isformed in a human body where the humerus 10 movably contacts the scapula12. The scapula 12 includes a glenoid fossa 14 that forms a socketagainst which the head of the humerus 10 articulates. At this socket,the scapula 12 includes cartilage 16 that facilitates such articulation.Beneath the cartilage is subchondral bone 18 that forms a wall of aglenoid vault 20 that defines a cavity which contains cancellous bone22. The subchondral bone 18 that forms the glenoid vault 20 defines aglenoid rim 24 at a periphery of the glenoid vault 20 that is attachedto the cartilage 16. During the lifetime of a patient, the glenoid fossa14 may become worn, especially at its posterior and/or superior portionsthereby causing severe shoulder pain and limiting the range of motion ofthe patient's shoulder joint. To alleviate such pain and increase thepatient's range of motion, a shoulder arthroplasty may be performed.Arthroplasty is the surgical replacement of one or more bone structuresof a joint with one or more prostheses.

Shoulder arthroplasty often involves replacement of the glenoid fossa ofthe scapula with a prosthetic glenoid component. The conventionalglenoid component typically provides a generally laterally or outwardlyfacing generally concave bearing surface against which a prosthetichumeral head (or, alternatively, the spared natural humeral head in thecase of a glenoid hemi-arthroplasty) may bear during operation of thejoint. The conventional glenoid component typically also includes agenerally medially or inwardly projecting stem for fixing the glenoidcomponent in a cavity constructed by suitably resecting the glenoidfossa 14 and suitably resecting cancellous bone 22 from the glenoidvault 20.

The goal of shoulder arthroplasty is to restore normal kinematics to theshoulder. Accordingly, known systems attempt to replicate the normalkinematics by carefully controlling the geometry of the articulatingsurfaces in the joint as well as the positioning of the prostheses inthe bones in which the prostheses are implanted. Thus, the articulatingsurface of a humeral component is typically spherical and positioning ofthe humeral component is accomplished by using the anatomical neck ofthe humerus as the reference plane for reconstruction of the humeralhead.

Traditionally, shoulder joints have been understood to exhibittranslation of the humeral component on the glenoid component inaddition to rotation. Thus, the articulating surface of the glenoid istypically formed with a radius of curvature that is much larger than theradius of curvature of the humeral component. The increased radius ofcurvature of the glenoid articulating surface can be from 2-6 mm largerthan the radius of curvature for the humeral component in these systems.

In known systems, the glenoid component is positioned in the geometriccenter of the glenoid fossa. The geometric center is established bygenerating a line from the most superior point of the glenoid rim to themost inferior point of the glenoid rim (“Saller's line”). A second lineis generated between the most posterior point of the glenoid rim and themost anterior point of the glenoid rim. The intersection of the twogenerated lines is considered to be the geometric center of the areacircumscribed by the glenoid rim. By way of example, FIG. 2 depicts asagittal view of the scapula 12. In FIG. 2, Saller's line 30 extendsbetween the most superior point 32 of the glenoid rim 24 to the mostinferior point 34 of the glenoid rim 24. A second line 36 extends fromthe most posterior point 38 of the glenoid rim 24 and the most anteriorpoint 40 of the glenoid rim. The geometric center 42 of the glenoidfossa 14 is located at the intersection of the line 36 and Saller's line30. As used herein, the terms anterior, posterior, superior, andinferior, unless otherwise specifically described, are used with respectto the orientation of the scapula 12 as depicted in FIG. 2.

Once a surgeon determines the placement of the glenoid component, aguide pin is positioned through the glenoid fossa. A reamer is then usedto shape the scapula to receive a glenoid component, typically byforming a cavity in the glenoid vault. For glenoid components includinga center peg for fixation of the glenoid component within the glenoidvault, a bore is drilled using the guide pin as a guide. The guide pinis then removed. For glenoid components including offset pegs inaddition to the center peg for fixation of the glenoid component withinthe glenoid vault, a drill guide is introduced into the prepared cavityand additional bores are drilled for each of the offset pegs. A trialglenoid component is then implanted in the prepared cavity and, if thefit appears to be satisfactory, the trial is removed and a glenoidcomponent is implanted in the prepared cavity.

There exists a need for a simplified method of implanting a glenoidcomponent. There is a further need for reducing the instrumentationrequired to properly prepare the scapula to receive a glenoid component.

SUMMARY OF THE INVENTION

The present invention in one embodiment provides an instrumentation kitfor use in preparing a shoulder to receive a glenoid component whichincludes at least one combination device, the combination deviceincluding a boring section configured to rotationally form a first borein a glenoid of a shoulder, a drive section operably connected to theboring section and configured to receive a rotational force, a reamingsection positioned proximally from the boring section and operablyconnected to the drive section, the reaming section configured torotationally ream a portion of the glenoid, and at least one drill guideconfigured to guide a drill bit and positioned so as to guide the drillbit to form a second bore in the shoulder at a location spaced apartfrom the first bore, wherein the reaming section and the boring sectionare positioned with respect to each other such that when the combinationdevice is positioned against the glenoid and the rotational force isapplied to the drive section, the boring section rotationally forms thefirst bore in the glenoid and the reaming section simultaneouslyrotationally reams a portion of the glenoid adjacent to the first bore.

In another embodiment, a method of preparing a shoulder to receive aglenoid component includes accessing a glenoid of a shoulder, applying arotational force to a combination device, forming a first bore in theglenoid with a rotating boring section of the combination device,forming a second bore in the glenoid at a location spaced apart from thefirst bore using a first drill guide defined by the combination device,and reaming a portion of the glenoid with a rotating reaming section ofthe combination device, wherein forming a first bore and reaming aportion of the glenoid occur simultaneously.

The above-noted features and advantages of the present invention, aswell as additional features and advantages, will be readily apparent tothose skilled in the art upon reference to the following detaileddescription and the accompanying drawings, which include a disclosure ofthe best mode of making and using the invention presently contemplated.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 depicts a coronal view of an anatomically normal shoulder joint.

FIG. 2 depicts a sagittal view of the shoulder joint of FIG. 1;

FIG. 3 depicts a bottom perspective view of a circular glenoid componentthat may be implanted in a scapula in accordance with principles of theinvention;

FIG. 4 depicts a bottom plan view of the circular glenoid component ofFIG. 3;

FIG. 5 depicts a side plan view of the circular glenoid component ofFIG. 3;

FIG. 6 depicts a side perspective view of a combination device that maybe used to simultaneously form a bore for receiving a peg of a glenoidcomponent and to ream a glenoid fossa to receive the glenoid component;

FIG. 7 depicts a bottom perspective view of the combination device ofFIG. 6 showing the guide bore extending from a distal tip of thecombination device;

FIG. 8 depicts a bottom plan view of the combination device of FIG. 6;

FIG. 9 depicts a side plan view of the combination device of FIG. 6showing the guide bore extending to a drive section which in thisembodiment is a hexagonally shaped bore in a body section of thecombination device;

FIG. 10 depicts a side plan view of a power extension which may be usedwith the combination device of FIG. 6 to couple a power rotary tool (notshown) to the combination device;

FIG. 11 depicts a bottom plan view of the power extension of FIG. 10showing a guide bore which extends from a distal tip of the powerextension to a proximal tip of the power extension;

FIG. 12 depicts a perspective view of the combination device of FIG. 6aligned with the power extension of FIG. 10;

FIG. 13 depicts a side plan view of the combination device of FIG. 6coupled with the power extension of FIG. 10 such that the respectiveguide bores of the combination device and the power extension arealigned;

FIG. 14 depicts a side plan view of a manual extension which may becoupled with the combination device of FIG. 6 manually position thecombination device;

FIG. 15 depicts a bottom plan view of the manual extension of FIG. 14showing a guide bore which extends from a distal tip of the manualextension along an axis defined by the distal portion of the manualextension;

FIG. 16 depicts a top plan view of the manual extension of FIG. 14showing the guide bore of FIG. 15;

FIG. 17 depicts a side plan view of the combination device of FIG. 6aligned with the manual extension of FIG. 14;

FIG. 18 depicts a side plan view of the combination device of FIG. 6coupled with the manual extension of FIG. 14 0 such that the respectiveguide bores of the combination device and the manual extension arealigned;

FIG. 19 depicts a medical procedure that may be used to implant thecircular glenoid component of FIG. 3 into a scapula using thecombination device of FIG. 6;

FIG. 20 depicts a perspective view of the scapula of FIG. 2 with a guidewire positioned in the scapula using a guide template and a guidetemplate manipulator;

FIG. 21 depicts a partial cross-sectional view of the scapula of FIG. 20with the combination device of FIG. 6 guided to a location adjacent tothe glenoid fossa by the guide wire of FIG. 20;

FIG. 22 depicts a partial cross-sectional view of the scapula of FIG. 20with the power extension of FIG. 10 coupled to the combination device ofFIG. 6, both the power extension and the combination device guided to alocation adjacent to the glenoid fossa by the guide wire of FIG. 20;

FIG. 23 depicts a partial cross-sectional view of the scapula of FIG. 20and the coupled power extension and combination device of FIG. 22 afterthe combination device has been used to simultaneously ream the glenoidfossa and form a bore in preparation for implanting the glenoidcomponent of FIG. 3 into the scapula;

FIG. 24 depicts a perspective view of the scapula of FIG. 23 after thepower extension has been removed;

FIG. 25 depicts a perspective view of the scapula of FIG. 24 after themanual extension of FIG. 14 has been guided by the wire guide of FIG. 20and coupled with the combination device of FIG. 6 allowing a user tomanually orient the combination device on the scapula; and

FIG. 26 depicts a perspective view of the scapula of FIG. 25 with thecombination device of FIG. 6 used to guide a drill bit to form a bore toreceive an offset peg of the glenoid component of FIG. 3 while themanual extension of FIG. 14 has been used to manually stabilize thecombination device on the scapula.

DETAILED DESCRIPTION

Like reference numerals refer to like parts throughout the followingdescription and the accompanying drawings.

FIGS. 3-5 depict a glenoid component 100. The glenoid component 100includes a body portion 102 including a spherical articulating surface104 and an opposite bone contacting surface 106. An outer wall 108extends away from the bone contacting surface 106 and defines an outerperiphery of the body portion 102. The bone contacting surface 106 isgenerally convex. A finned center peg 110 extends away from the nadir ofthe bone contacting surface 106 as viewed in FIG. 5. Three offset pegs112, 114, and 116 extend away from the bone contacting surface 106 atlocations between the center peg 110 and the outer wall 108. The nadir118 of the spherical articulating surface 104 is located on thecenterline 120 of the glenoid component 100.

The glenoid component 100 in this embodiment is an integrally formedunit made from a durable biocompatible plastic or any other suitabledurable biocompatible material. For example, the glenoid component 100may be made from a polyethylene. One particular polyethylene that iswell suited for glenoid component 100 is a high molecular weightpolyethylene, for example ultra-high molecular weight polyethylene(“UHMWPE”). One such UHMWPE is sold as by Johnson & Johnson of NewBrunswick, N.J. as MARATHON™ UHMWPE and is more fully described in U.S.Pat. Nos. 6,228,900 and 6,281,264 to McKellop, which are incorporatedherein by reference.

In embodiments wherein the articulating surface 104 and the otherportions of the glenoid component 100 are made from different materials,the portions of the glenoid component 100 other than the articulatingsurface 104 may be made from a suitable biocompatible metal such as, forexample, a cobalt chromium alloy, a stainless steel alloy, a titaniumalloy, or any other suitable durable material. In these embodiments, thearticulating surface 104 is secured to the body portion 102 in anysuitable manner. For example, articulating surface 104 may be bonded tobody portion 102, or articulating surface 104 could be made frompolyethylene and compression molded to body portion 102. Alternately,the articulating surface 104 may be glued to the body portion 102 by,for example, an adhesive. Alternatively, articulating surface 104 may bemechanically interlocked to the body portion 102 by taper locking orotherwise press-fitting the articulating surface 104 into the body 102and the body 102 may include any other suitable interlocking features,for example, rib(s), lip(s), detent(s), and/or other protrusion(s) andmating groove(s), channel(s), or indent(s) (not shown).

In alternative embodiments, one or more of the outer wall 108, the bonecontacting surface 106, the center peg 110 and the offset pegs 112, 114,and 116 may include a porous coating to facilitate bone in-growth intothe glenoid component 100. The porous coating may be any suitable porouscoating and may for example be POROCOAT®, a product of Johnson & Johnsonof New Brunswick, N.J. and more fully described in U.S. Pat. No.3,855,638 to Pilliar, which is incorporated herein by reference.

In order to implant the glenoid component 100 into a scapula, thescapula must first be prepared to receive the glenoid component 100. Adevice which can be used to prepare the scapula to receive the glenoidcomponent 100 is depicted in FIGS. 6-9. With reference to FIGS. 6-9, acombination device 130 includes a drive section 132, a body section 134,and a drill or boring section 136. The drive section 132 in thisembodiment is a hexagonally shaped bore defined in the body section 134.

A number of reaming fins 140 extend from the lower central portion ofthe body section 134 toward the drill section 136. The reaming fins 140curve proximally and outwardly from the lower central portion of thebody section 134 to the outer periphery of the body section 134. Thereaming fins 140 include an arcuate leading edge 142. The body section134 defines a number of through-holes at locations between adjacentreaming fins 140. The through-holes in the embodiment of FIGS. 6-9include three drill guides 146 and three ports 148.

The drill section 136 extends away from the body section 134 to a distaltip 150. Two flutes 152 and 154 extend helically about the drill section136 between the body section 134 and the distal tip 150. A guide bore156 extends from the distal tip 150 to the drive section 132.

As discussed in further detail below, a kit may include one or morecombination devices 130 along with various instrumentation to facilitateuse of the combination device 130. By way of example, FIG. 10 depicts apower extension 160 that may be included in the kit. The power extension160 includes a power receiving portion 162 and a power transfer portion164. The power receiving portion 162 is sized and configured to couplewith a power tool and includes a pair of opposing power receiving flats166 and a pair of coupling grooves 168 and 170 which extend about thepower receiving portion 162 between the power receiving flats 166.

The power transfer portion 164 is shaped to be complimentary to thedrive section 132. In the embodiment of FIGS. 10 and 11, the powertransfer portion 164 is thus a hexagonally shaped protrusion sized tofit within the drive section 132. A guide bore 172 extends from thedistal tip of the power transfer portion 164 to the proximal end of thepower receiving portion 162.

To couple the combination device 130 with the power extension 160, thepower transfer portion 164 is aligned with the drive section 132 asshown in FIG. 12. The combination device 130 with the power extension160 are then moved toward each other such that the power transferportion 164 enters into the drive section 132 resulting in theconfiguration of FIG. 13. In FIG. 13, the guide bore 156 of thecombination device 130 is aligned with the guide bore 172 of the powerextension 160.

FIGS. 14-16 depict a manual extension 180 that may also be included inthe kit. The manual extension 180 includes a handle portion 182 and apower transfer portion 184. The handle portion 182 is sized andconfigured to be easily gripped and defines a first axis 186.

The power transfer portion 184 includes a hexagonal protuberance 188shaped to be complimentary to the drive section 132. The power transferportion 184 defines a second axis 190. The second axis 190 forms anangle 192 of about 145 degrees with the first axis 186. A guide bore 194extends from the distal tip of the power transfer portion 184 along thesecond axis 190.

To couple the combination device 130 with the manual extension 180, thepower transfer portion 184 is aligned with the drive section 132 asshown in FIG. 17. The combination device 130 and the manual extension180 are then moved toward each other such that the hexagonalprotuberance 188 enters into the drive section 132 resulting in theconfiguration of FIG. 18.

In FIG. 18, the guide bore 156 of the combination device 130 is alignedwith the guide bore 194 of the manual extension 180. Beneficially, theangle 192 (see FIG. 14) between the handle portion 182 and the powertransfer portion 184 allows a user to easily see the guide bore 194,thereby assisting in alignment of the power transfer portion 184 withthe drive section 132 or, as discussed in more detail below, with aguide wire extending through the guide bore 156. The angle 192 furtherprovides a mechanical advantage in maintaining the combination device130 in a desired location as also discussed below.

A kit including the combination device 130, the power extension 160, andthe manual extension 180 may be used in preparing a shoulder to receivea glenoid component such as glenoid component 100 in accordance with aprocedure 200 depicted in FIG. 19. Initially, a scapula is accessed atblock 202 in accordance with a desired surgical approach. At block 204,a guide wire, which may be provided in a kit along with otherinstrumentation used in the procedure 200, is positioned on the scapula.Positioning of the guide wire may be computer aided. In one embodiment,the guide wire is positioned based upon identification of the center ofan inferior glenoid circle. By way of example, FIG. 20 depicts a guidewire 206 implanted into a glenoid 14 of the scapula 12. In theembodiment of FIG. 20, the guide wire 206 has been positioned with theaid of a guide plate 208 and a guide plate manipulator 210.

Once the guide wire is positioned, a combination device 130 ispositioned with the guide bore 156 aligned with the guide wire. Thecombination device 130 is then moved toward the guide wire and at block212 the guide wire is used to guide the combination device 130 to alocation adjacent to the glenoid 14 of the scapula 12 as depicted inFIG. 21.

At block 214, a power extension 160 is coupled to the combination device130 substantially in the manner described above. Since the guide wire206 extends through the guide bore 156 of the combination device 130,however, coupling of the power extension 160 to the combination device130 begins by aligning the guide bore 172 of the power extension 160with the guide wire 206. The guide wire 206 thus guides the powerextension 160 to the combination device 130. Some rotation of the powerextension 160 may be required to align the power transfer portion 164with the drive section 132 of the combination device 130 to allowcoupling of the power extension 160 with the combination device 130. Theresulting configuration is depicted in FIG. 22.

A rotary tool (not shown) is then coupled to the combination device 130at block 216. In some embodiments, a rotary tool may be directly coupledto the combination device 130. In this example, the power extension 160is coupled to the combination device 130 as described above. Thus, therotary tool is coupled to the power receiving portion 162 of the powerextension 160 so as to be indirectly coupled to the combination device130.

Power is then applied to the rotary tool causing the rotary tool torotate the power extension 160. Rotary force is transferred to the drivesection 132 of the combination device 130 through the power transferportion 164 (see FIG. 12). As the combination device 130 initiallyrotates about the guide wire 206, the drill section 136 contacts theglenoid 14 and begins to bore a hole in the glenoid 14. The reaming fins140, however, are initially spaced apart from the glenoid 14 as depictedin FIG. 22. Accordingly, no reaming occurs. As a hole is formed in theglenoid 14 by the drill section 136, the combination device 130 isguided by the guide wire such that the reaming fins 140 come intocontact with the glenoid 14 as depicted in FIG. 23. Continued rotationof the combination device 130 with the rotary tool thus causessimultaneous reaming of the glenoid 14 with the reaming fins 140 andboring of the scapula 12 with the drill section 136 at block 218.

Once the glenoid 14 has been reamed to the desired depth, the power toolis de-energized and disconnected at block 220. The size of the drillsection 136, both in length and diameter, is selected to becomplimentary to the size of the center peg 110 of the glenoid component100. Thus, upon completion of the reaming, the bore formed by the drillsection is sized to receive the finned center peg 110. The powerextension 160 is disconnected at block 222, resulting in theconfiguration of FIG. 24.

At block 224, the manual extension 180 is coupled to the combinationdevice 130 substantially in the manner described above. Since the guidewire 206 extends through the guide bore 156 of the combination device130, however, coupling of the manual extension 180 to the combinationdevice 130 begins by aligning the guide bore 194 of the manual extension180 with the guide wire 206. The guide wire 206 thus guides the manualextension 180 to the combination device 130. Some rotation of the manualextension 180 may be required to align the hexagonal protuberance 188 ofthe manual extension 180 with the drive section 132 of the combinationdevice 130 to allow coupling of the manual extension 180 with thecombination device 130. The resulting configuration is depicted in FIG.25.

Once the manual extension 180 has been coupled with the combinationdevice 130, the manual extension 180 may be used to align thecombination device 130 at block 226 as explained with reference to FIG.25. Specifically, the handle portion 182 may be rotated about the axis228 defined by the guide wire 206. Rotation of the handle portion 182about the axis 228 causes rotation of the combination device 130 aboutthe axis 228.

The curvature of the manual extension 180 resulting from the angle 192(see FIG. 14) provides a surgeon with a relatively unobstructed view ofthe combination device 130. Accordingly, the surgeon may view the reamedsurface of the glenoid 14 through the drill guides 146. This allows asurgeon to view the location in the shoulder 12 at which the offsetfixation pegs 112, 114, and 116 of the glenoid component 100 will beanchored. In the embodiments in this example wherein the number andpositioning of the drill guides 146 are complimentary to the number andpositioning of the offset fixation pegs 112, 114, and 116, such that thedrill guide axes are parallel to a boring axis of the boring section136, the surgeon may orient the combination device 130 such that each ofthe drill guides 146 is aligned with portions of the shoulder that canprovide a good anchor for the offset fixation pegs 112, 114, and 116.

Once the combination device 130 is aligned at the block 226, a drill bitis inserted through one of the drill guides 146 to drill an additionalbore at a location spaced apart from the first bore formed using thedrill section 136 at block 230. By way of example, FIG. 26 depicts adrill bit 232 positioned in a first circular drill guide 146 of thecombination device 130. The manual extension 180 may be used to steadythe combination device 130 during the drilling process. The offset ofthe handle portion 182 from the axis 228 provided by the angle 192results in a mechanical advantage in maintaining the combination device130 at the desired orientation. Blocks 226 and 30 may be repeated asdesired to form additional holes through, e.g., a second circular drillguide 146.

Once all of the desired holes are formed, the combination device 130 isremoved at block 234. The manual extension 180 may be used to aid inremoval of the combination device 130. At block 236, the glenoidcomponent is implanted. In this example, the glenoid component 100 has alower bone contacting surface 106 shaped complimentary to the reamingcross-section of the reaming fins 140. Thus, in this example the lowerbone contacting surface 106 is curved complimentary to the distal curveof the reaming fins 140. In other embodiments, the reaming fins 140 maybe configured to produce a flat bottomed area if a glenoid componentwith a flat lower bone contacting surface is used. Accordingly, a kitmay include different combination devices with differently shapedreaming cross-sections.

The combination device 130 and the procedure 200 may be used incombination with various of the devices and procedures disclosed in therelated applications identified above. Thus, while the combinationdevice 130 is useful in implanting a circular glenoid device at thecenter of the inferior glenoid circle, the combination device 130 may beused to implant other glenoid components, including non-circular glenoidcomponents, at any desired location in a glenoid. Preferably, thediameter of the reaming cross-section of the combination device 130 isselected to match the largest diameter of a glenoid component. Thus,while a kit may include one or more combination devices 130 of the samereaming diameter, a kit may alternatively include a number ofcombination devices with differently sized reaming diameters.

The foregoing description of the invention is illustrative only, and isnot intended to limit the scope of the invention to the precise termsset forth. Further, although the invention has been described in detailwith reference to certain illustrative embodiments, variations andmodifications exist within the scope and spirit of the invention asdescribed and defined in the following claims.

What is claimed is:
 1. A method of using an instrumentation kit toprepare a shoulder to receive a glenoid component comprising: selectinga combination device from a plurality of combination devices in theinstrumentation kit, each of the plurality of combination devicesincluding a respective drill section with a combination of a length anda width that is different from a combination of a length and a width ofeach of the drill sections of the other of the plurality of combinationdevices, the combination of the length and the width of the drillsection of the selected combination device complementary to a length anda width of a peg of a selected glenoid component; applying a rotationalforce to the selected combination device while contacting an accessedglenoid with the drill section of the selected combination device toform a first bore with a bore axis in the accessed glenoid; and forminga second bore by guiding a drill bit into the accessed glenoid, using adrill guide defined by the selected combination device, to a locationwhereat a portion of the drill bit is located directly radiallyoutwardly of the drill section of the selected combination device. 2.The method of claim 1, wherein forming the second bore furthercomprises: forming the second bore parallel to the first bore.
 3. Themethod of claim 1, further comprising: reaming a portion of the accessedglenoid with a rotating reaming section of the selected combinationdevice while forming the first bore.
 4. The method of claim 3, whereinreaming the portion of the accessed glenoid with the rotating reamingsection comprises: forming an arcuate surface extending radiallyoutwardly from the first bore with the rotating reaming section of theselected combination device while forming the first bore.
 5. The methodof claim 3, wherein reaming the portion of the accessed glenoid with therotating reaming section comprises: forming a flat surface extendingradially outwardly from the first bore with the rotating reaming sectionof the selected combination device while forming the first bore.
 6. Themethod of claim 1, further comprising: positioning a guide wire providedin the instrumentation kit in the glenoid; aligning a guide bore in theselected combination device with the positioned guide wire; and guidingthe selected combination device with the positioned guide wire whileapplying the rotational force to the selected combination device.
 7. Themethod of claim 1, further comprising: coupling a power extension,provided with the instrumentation kit, with the combination device;applying the rotational force to the selected combination device throughthe coupled power extension; and removing the power extension afterforming the first bore and before forming the second bore.
 8. The methodof claim 7, further comprising: coupling a manual extension, providedwith the instrumentation kit, with the combination device after removingthe power extension and before forming the second bore.
 9. The method ofclaim 8, wherein coupling the manual extension comprises: aligning aguide bore in the manual extension with a guide wire positioned in theaccessed glenoid; and after aligning the guide bore in the manualextension with the positioned guide wire, moving the manual extensiontoward the positioned guide wire and into contact with the combinationdevice.
 10. The method of claim 9, wherein moving the manual extensiontoward the positioned guide wire comprises: moving the manual extensiontoward the positioned guide wire using a handle portion of the manualextension which is not aligned with the positioned guide wire.
 11. Themethod of claim 10, further comprising: rotating the combination deviceusing the manual extension, after forming the first bore, therebyaligning the drill bit with a desired portion of the accessed glenoid,wherein forming the second bore further comprises; forming the secondbore in the desired portion of the accessed glenoid.
 12. The method ofclaim 8, wherein: coupling the power extension with the combinationdevice comprises coupling the power extension with a drive section ofthe combination device; and coupling the manual extension with thecombination device after removing the power extension and before formingthe second bore comprises coupling the manual extension with the drivesection of the combination device.